PFS Pt Acct Denial Spclst - PFS Hospital - Miamisburg - FT/Days - Kettering Health

Kettering Health is a not-for-profit system of 13 medical centers and more than 120 outpatient facilities serving southwest Ohio. We are committed to transforming the health care experience with high-quality care for every stage of life. Our service-oriented mission is in action every day, whether it’s by providing care in our facilities, training the next generation of health care professionals, or serving others through international outreach.

Campus Overview:

Kettering Health Miamisburg  

• Serving the residents of Warren, Butler, and Southern Montgomery counties for over 40 years.
• Kettering Health Miamisburg, formerly Sycamore Medical Center, is a full-service hospital located minutes west of the Dayton Mall on Miamisburg-Centerville Road off I-75 in Miamisburg, Ohio.
• The cornerstone services for KH Miamisburg have been Bariatric surgeries and Orthopedic care. 
• Expanded services include emergency care, sleep center, mammography, breast MRI, cardiac catheterization lab, wound center and DEXA scanning. 
• 142 bed facility
• Awarded with 100 Top Hospital by IBM Watson Health for the 10^th time in 2019.
• In 2020, KH Miamisburg received an “A” from the Leapfrog Group, a national patient safety watchdog, ranking among the safest hospitals in the United States.
• Accredited by the American College of Emergency Physicians as a Level 3 Geriatric Emergency Department.
• KH Miamisburg received several awards from Healthgrades:
  • Outstanding Patient Experience Award (2017-2019)
  • America’s 100 Best Hospitals for Prostate Surgery Award (2020)
  • Joint Replacement Excellence Award (2020)

Responsibilities:

• Under the direction of the Patient Accounts Manager or Patient Accounts Supervisor and guidance of the Team Lead the Patient Accounts Specialist is highly involved in all aspects of medical billing, and is responsible for escalated follow-up and denial work.
• Participates in training and auditing of Patient Account Representatives.  
• Works special projects as assigned. 
• Effective in identifying and analyzing problems.
• Generates alternatives and identifies possible solutions.
•  Timely resolution of claim edits allowing timely claim submission
•  Timely follow-up of unpaid claims, worked to ensure maximum reimbursement following compliant standards
•  Ability to work independently as well as collaboratively within a team environment  
•  Excellent problem-solving skills
•  Creative ability to escalation of appeals
•  Excellent verbal, written and customer service communication skills.

Requirements:  

• Experience in Microsoft tools Epic EMR Experience (Preferred) Relay Health/ePremis Experience (Preferred)      
• High School diploma or equivalent required
• Minimum of one years’ experience in health care denials
•  Experience with the Revenue Cycle – registration, medical records, billing, coding, etc.
•  Experience with managed care contract terms and federal payer guidelines
•  Experience with medical necessity guidelines and care coordination/case management functions
•  Experience with hospital billing (UB92 form) and coding requirements · Understanding of Revenue Cycle Processes
•  In depth understanding of explanation of benefits (EOB's)